|LETTER TO THE EDITOR
|Year : 2014 | Volume
| Issue : 5 | Page : 50-51
Marjolin's ulcer: A rare report
Kumar Parimalam, M Vinnarasan, G Senthil, V Arumugakani, BM Amutha
Department of Dermatology, Thanjavur Medical College, Thanjavur, Tamil Nadu, India
|Date of Web Publication||13-Nov-2014|
Dr. Kumar Parimalam
Old 33A, New 4/1, East Ellaiamman Koil Street, Dr. Radhakrishnan Nagar, Thiruvottiyur, Chennai - 60 0019, Tamil Nadu
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Parimalam K, Vinnarasan M, Senthil G, Arumugakani V, Amutha B M. Marjolin's ulcer: A rare report. Indian Dermatol Online J 2014;5, Suppl S1:50-1
|How to cite this URL:|
Parimalam K, Vinnarasan M, Senthil G, Arumugakani V, Amutha B M. Marjolin's ulcer: A rare report. Indian Dermatol Online J [serial online] 2014 [cited 2021 May 10];5, Suppl S1:50-1. Available from: https://www.idoj.in/text.asp?2014/5/5/50/144534
Marjolin ulcer is the term commonly used to describe squamous cell carcinoma (SCC) arising on scar tissue. It is a malignant transformation of a chronic ulcer, sinus tract, fistula or long-standing scar of various etiologies. Jame Nicholas Marjolin in 1828 published the classical description of Marjolin's ulcer. The most frequent malignancy that develops in burns scars is squamous in type.  Melanoma, schwannoma, sarcoma, trichilemmal carcinoma have also been described.  Limbs are the common site for Marjolin's ulcer. Two different clinical presentations are common ulcerative form and less frequent, exophytic papillary form. 
We report a case of a 58-year-old lady who developed ulcerative and exophytic mass from a 10 year old burns scar over the back She reported with discomfort over the back to the family physician who found and ulcer over the scar and suspected malignancy. Within four months, the ulcer rapidly progressed to a cauliflower-shaped growth. She was not a diabetic or hypertensive. There was no family history of malignancy. On examination, there was a large exophytic ulcerated growth and a small superficial ulcer arising from a large depigmented atrophic scar over the back [Figure 1]. There was no lymphadenopathy. The other skin and mucosal sites appeared normal. Relevant investigations were normal. Histopathology showed a well-differentiated SCC with horn pearls [Figure 2]. She was advised radiation therapy.
|Figure 1: An exophytic ulcerated growth and a small superficial ulcer with intervening erosion over a large depigmented atrophic scar|
Click here to view
|Figure 2: Histopathology H and E, ×400 showing well-differentiated squamous cell carcinoma with horn pearls|
Click here to view
The exact pathogenesis of Marjolin's ulcer remains unclear. Theories suggest that cellular mutations as a result of toxins released by damaged, ischaemic and nutritionally deficient tissues are responsible for neoplastic change, with a locally impaired immune function contributing as trigger. Persistence of burns ulcer, induration or elevation of margin of such ulcer, ulceration or nodule formation over a burns scar may indicate malignant transformation. The latent period is shorter in elderly and in cases of basal cell epithelioma. Metastasis among squamous carcinomas following a burns scar is much more common than among those associated with actinic damage.  Punch biopsy should be avoided, due to the focal nature of the malignant changes in burn scar.  In our case, the spine region being more prone for pressure-induced damage, the resultant necrosis could have initiated the malignant process. This case is reported the rarity of occurrence of Marjolin's ulcer over the back, presenting as both ulcerative and exophytic growth. Even a small abrasion over a long standing burns scar should be viewed with suspicion. All burn scars should be grafted as the incidence of carcinoma is reduced if such wounds are grafted at an early stage.
| Acknowledgment|| |
We acknowledge the Department of Pathology, Thanjavur Medical College for facilitating in getting the histology slide.
| References|| |
Tamura A, Ohnishi K, Ishikawa O, Miyachi Y. Flow cytometric DNA content analysis on squamous cell carcinomas according to the preceding lesions. Br J Dermatol 1996;134:40-3.
Ko T, Tada H, Hatoko M, Muramatsu T, Shirai T. Trichilemmal carcinoma developing in a burn scar: A report of two cases. J Dermatol 1996; 23:463-8.
Das S, Roy AK, Maiti A. Marjolinulcer with multifocal origin. Indian J Dermatol 2009;54:14-5.
Arons MS, Lynch JB, Lewis SR, Blocker TG Jr. Scar tissue carcinoma. I. A clinical study with special reference to burn scar carcinoma. Ann Surg 1965; 161:170-88.
Phillips TJ, Salman SM, Bhawan J, Rogers GS. Burn scar carcinoma. Diagnosis and management. Dermatol Surg 1998;24:561-5.
[Figure 1], [Figure 2]